Do you have an accurate transfer-in and transfer-out formula for your BRACES patients? Do you have an accurate transfer-in and transfer-out formula for your ALIGNER patients? Braces and Aligner charges and adjustments are very different and this pearl may help you to understand why.
For a transfer-IN patient, just charging the other orthodontist’s patient account balance is unfair to you, just as it is unfair for other orthodontists to charge your transfer-out patient’s account balance. You should only charge a transfer-in patient for the services you provided, nothing more and nothing less. You should only charge a transfer-out patient for the services you have provided, adjusting their account for what you did not provide, nothing more and nothing less. This is especially true for Align patient transfers because of the significant lab fees and shorter chairtime for aligner treatment vs. braces treatment. The purpose of this pearl is to give you the formulas required to do this.
BRACES patients require fairly simple transfer-in charge and transfer-out adjustment formulas, since braces treatment is similar from practice to practice, appointment time wise, taking about 700-850 min of total Tx time for a 24-mo Tx. The percentages used below are average; yours may vary:
1) Communications: Exam/records, Tx planning and initial braces insertion (typically 25% of Tx time)
2) Treatment: moving teeth for 18-30 months with appliances, archwires, elastics, etc. (typically 55% of Tx time = 2.3%/mo)
3) Retention: removal of attachments, cleaning and impressions/scans for retainers, insert retainers and one or two retention visits (typically 20% of Tx time)
Thus for a Transfer-IN case, you would charge according to the Fee formula:
(Your $ Full Fee) x [.023 x (Months of Tx needed) + 0.20]
Example-1: $6,000 x [.023 x 8 months + 0.20] = $6,000 x 0.38 = $2,304 Fee for the 8 months of Tx that you will provide
Example-2: $6,000 x [.023 x 20 months + 0.20] = $6,000 x 0.66 = $3,960 Fee for the 20 months of Tx that you will provide
This fee would be higher if you have to insert more braces (bands/brackets) for your Tx.
And for a Transfer-OUT adjustment you would use the ADJ formula:
(Your $ Full Fee) x [(.023 x Months of Tx left to do) + 0.20]
Example-1: $6,000 x [(.023 x 8 months) + 0.2] = $6,000 x 0.38 = $2.304 ADJ for the 16 months of Tx that you already provided
Example-2: $6,000 x [(.023 x 20 months) + 0.2] = $6,000 x 0.66 = $3,960 ADJ for the 4 months of Tx that you already provided
This adjustment would be lower if they were very poor cooperators (broken appliances or missed appointments).
ALIGNER patient calculations depend on whether you do less than 20 or do more than 100 aligner starts/year
If you do less than 20 cases/year your Tx time is typically longer and your lab fees are higher than if you treat more than 100 cases/year, as indicated in my pearl "How much can Invisible Aligners Increase Your NET”:
It is becoming more standard though to follow a prescribed sequence of appointments taking about 280-380 min of total Tx time for a full case. The percentages used below are average but vary greatly; you should calculate your own percentages based on your sequence of appointments and the time that they take. Typical percentages are:
1) Communications: Exam/records, scanning, Tx planning and paying for the aligners (typically 30% of Tx time plus aligner lab fees)
2) Treatment–18-24 months: Insertion of initial aligners & attachments, more aligner appointments and attachments, IPR, etc. (typically 45% of Tx time or about 2.0% /month)
3) Retention: removal of attachments, records and impressions/scans for retainers, insert retainers and one retention visit (typically 25% of Tx time)
An aligner lab fee of $1,800 is used in the examples below; you should use the lab fees you paid (or will pay) for these calculations.
Thus for a Transfer-IN 24-mo aligner case you would charge according to the Fee formula:
(Your Aligner Full Fee minus Lab costs) x [.02 x Months of Tx needed + 0.25] + any new Lab costs
Example-1: ($6,000 - $1,800) x [.02 x 8 months + 0.25] = $4,200 x [0.41] = $1,722 + $ Lab fees for the 8-mo of Tx you will provide, mostly for retention Tx
Example-2: ($6,000 - $1,800) x [.02 x 20 months + 0.25] = $4,200 x [0.65] = $2,730+ $ new lab fees for the 20-mo of Tx you will provide, much for retention Tx
Thus for a Transfer-OUT 24-mo aligner case you would adjust the patient’s account using the Fee formula:
(Your Aligner Full Fee – Aligner Lab costs) x [.02 x (Months of Tx left to do) + 0.25] – your Lab costs
Example-1: ($6,000 - $1,800) x [.02 x 8 months + 0.25] = $4,200 x [0.41] = $1,722 – $1,800 Lab fees = $78 ADJ for your 16 mo of Tx you provided
Example-2: ($6,000 - $1,800) x [.02 x 18 months + 0.25] = $4,200 x [0.61] = $2,562 - $1,800 Lab fees = $762 ADJ for the 6 mo of Tx you provided
As you can see, the up front costs (appointments + lab costs) are significantly higher in an aligner case than in a braces case, mostly affecting the transfer-out adjustment.
As mentioned, you should determine your own percentages, which you can calculate from your own appointment Tx sequences and appointment times.
Thank you.